The emerging era of shifting health costs to employees and an aging workforce with more chronic diseases will require worksite programs that are cost effective and sustainable and health care consumers who are active partners in their care. This study is a randomized, controlled trial comparing the effectiveness of a standard worksite health promotion intervention with an innovative activated health care consumer intervention to reduce health risks and decrease inappropriate health care costs and absenteeism. The standard intervention assesses employee risks and interests and uses participatory research principles for program design and delivery. These programs include substantial promotional efforts and multiple educational offerings to address health behaviors such as tobacco cessation, and chronic disease management. Such programs generally do not emphasize links with health care delivery systems. In contrast, the activated consumer intervention will offer comparatively shorter education sessions and will be closely connected to the employees' use of health care systems. The activated consumer intervention includes decision tools, skills development for working with healthcare providers and education about preparing for medical emergencies including terrorist threats. Our aims include the development of an activated consumer intervention, a comparison of the cost effectiveness of the interventions in reducing risks, health care costs and absenteeism and a comparison of the sustainability of the interventions. The study design is a nested (hierarchical, multilevel) design. Within each company, three sites are chosen and randomly assigned to the control site or one of the two interventions. We hypothesize that the activated consumer intervention will be more cost-effective than the standard health promotion intervention in decreasing avoidable health claims costs and in reducing absenteeism.